DBT Diary Cards | Why I Fill Them Out

Yesterday in DBT (Dialectical Behavior Therapy) class, I felt a bit like the teacher's pet. When the doctor asked who had filled out their Diary Cards, I was the only one to raise my hand (which made made me feel a little embarrassed, but to be honest, I liked the look of approval from our therapist.)

This led our therapist to talk to the group about "Therapy Interference" - behaviors that stand in the way of therapy.

She went around the room and asked everyone to talk about why they thought they didn't follow through with the homework of filling out the diary cards. What was the "interference"? A variety of honest answers were given by members of the class, such as:

  • Feeling overwhelmed by the card
  • Not understanding the card's purpose, how to use it, or how it would really help
  • Not feeling invested in doing things to help themselves/their recovery
  • Putting other priorities first

When it came time for me to speak, I had a chance to share why I do fill out my diary cards:
  • I've stepped out in trust with all of the other recommended homework assignments for this DBT group. And each time, even though they often didn't make sense at first and even seemed like a waste of time, I actually gained something or learned something new. I figured this situation would be the same. Don't get me wrong. I felt ALL of the reasons (above) that were given by my group mates, but I just decided to give it a try anyway.
  • In all honesty, I like the opportunity for the positive attention that I get when I complete my homework assignments. Because I haven't been the best at keeping and maintaining friendships, I don't have a lot of social time in my life right now.  When I come to group, it is my safe place to talk about what's really going on and to get feedback and suggestions from others who are doing the work and from the doctor(s). I know it may sound lame, but it's truthfully one of the reasons that I follow through on my diary cards.
  • Even after just the first week of keeping a record, when I looked at the card, I found it very interesting to see that I use my skills on a very regular basis. It turns out that all of this practicing has caused me to integrate DBT skills as a regular part of my everyday life. That observation encouraged me. It means that the Dialectical Behavior Therapy is working and that I am changing and growing. Situations that, in the past, may have propelled me into a crisis are more than often now quelled by my ability to draw upon the the skills and turn to them instead of behaviors that are self harming or sabotaging.
  • I found it interesting to see that I use more than one skill every day - whether that day is challenging or pretty easy going.
  • I noticed that I don't check off certain skills at all or rarely ever - a sure indication of areas in which I can continue to grow and learn additional ways of regulating my emotions, being in relationship with others, tolerating distress, and being more mindful.

Here is one of my actual recent DBT Diary Cards.  I think we will eventually be learning how to use the top portion, but for now, our group only uses the bottom part:

Click to enlarge

For your reference, here is a blank form.

Blank copy. I am not sure which book
the hospital uses to copy this form.
No copyright infringement intended.

Whether you are someone who diligently fills out his or her diary card, someone who has difficulty following through on this homework, or even if you haven't even been introduced to this assignment yet, I hope you have found some insight or encouragement from this post.  Feel free to ask me any questions, and I'll respond in the comment area below. 

In the meantime, I am also taking an iPhone DBT app for a test drive. It allows you to update your skills every day and then email your diary card to your therapist in pdf format.  Once I have some more experience with it, I'll do a review and let you know how it works.

Thank you for reading.

More soon.

The Psychic Borderline | Reading Others & Identity Issues

Ok. So I'm not *technically* psychic, but I, like many other people with Borderline Personality Disorder, BPD traits, or emotional sensitivity, have an interesting ability to "read" people.

My therapist has clarified that the ability to do this is actually a learned survival skill.

For those who can relate to what I'll describe in this article, somehow, somewhere along the way, we may have unconsciously realized that if we could look a person over, effectively sum up what they are all about, and interact with them according to what we've read, we would be safe.

Our needs would get met.

Let me give you an example that supports this. My father was the type of person who could be loving and kind in one moment, but \t if you said the wrong words or did the wrong actions -- and you never knew what those were on any given day -- he would, without warning, become very angry and sometimes even dangerously violent.

As a child, I subconsciously learned how to behave around my father in ways that would reduce my risk of being hurt by him. In essence, I learned to read him and then interact with and behave accordingly.  I'd choose my words and actions very carefully. I'd be watching his body language...his facial expressions, his tone of voice, the energy that he was giving off.

The "me" around my father behaved very differently from the "me" I was when I was with my teachers at school or even with my mother. I read them, and responded accordingly to them, too.

Evidently, this skill became somehow psychologically wired within me, and it wasn't until I started DBT (Dialectical Behavior Therapy) that I began to see how this contributed to my lack of a strong sense of identity.

I was so frequently reading and responding to other people in ways I believed would cause them to accept and like me or not hurt me, that I never really developed my own unique sense of me.

I'd see glimpses of myself now and then, but if I thought I had an opinion about something then engaged in a conversation with someone whose acceptance, love, or approval I desired, and their opinion was different from mine, I instantly and willingly dropped any preference I had and quickly adopted their point of view.

The interesting thing is that I didn't even mind. It was as if making that choice didn't matter in terms of feeling like a self-sacrifice,  because in my mind it was necessary for my survival.

I truly had no sense of attachment to any idea or belief. I just wanted to be loved, accepted, and to feel safe. Those were my priorities, and they served me well as a child.

But, as an adult, they became a hindrance. Similar to Julia Robert's character in the movie, "Runaway Bride," I changed all the time to mirror the needs, likes, and desires of my partners over the years.

There is a scene in that movie where someone asks Julia's character, "So, how do you like your eggs?"

Her answer changed -- every time -- to match that of her current boyfriend or fiancĂ©.  There are other telltale signs that her character may be Borderline. Perhaps you can name a few if you've seen the movie.

The egg thing really spoke to me, though, at a time when I was struggling with my own sense of self. It was a bit of a "wake up" moment.

Still, for me, it wasn't until I had a literal identity crisis, exhausted from trying to be everything to everyone that I realized I had no idea who I really was and that I really needed help.

This led to my BPD diagnosis back in 2010, though it was clear to me I'd been suffering from it for quite some time undiagnosed.

I am now in recovery from BPD and no longer meet the criteria for the diagnosis. I have a strong sense of identity and am aware when those mind-reading thoughts pop up and I challenge them.

I fact check and ask people questions. And, I am now the same me from situation to situation and person to person.

It *is* possible. You can learn more about my journey and what helped here.

If you notice that you're making assumptions about what other people are thinking, feeling, or their intentions, consider whether you could be engaging in the distorted thinking style of mind reading.

While sometimes we'll be accurate in our "readings" using our intuition, tapping into our past experiences, and being sensitive to such things, past trauma can sometimes cause us to see think we know what other people are thinking, feeling or intending and, because we're seeing things through a trauma lens, we may be really off-base.

Check the facts and check in with yourself about any self-care you may be needing. 

I hope this post has helped you in some way...whether you have BPD, love or care for someone who does, or if you are treating patients or clients with Borderline Personality Disorder.

Here's that eggs scene with Julia Roberts:

Thanks for reading.

In kindness,
Debbie DeMarco Bennett, BSc., CLC
DBT-trained Certified Life Coach
For more info on Debbie and her online
DBT-informed courses, visit emotionallysensitive.com

This article was updated 11/6/2018 (originally posted 2/28/12)

How DBT Has Been Helping Me | Dialectical Behavior Therapy for Borderline Personality Disorder (BPD)

As I've previously shared, I was diagnosed with BPD (Borderline Personality Disorder) during an IOP (Intensive Outpatient Program) at my local hospital.  I had been doing pretty well, prior to my "breakdown" that led to the hospitalization.  I was working, my relationship with my significant other was stable. It took a trigger to catapult me into an emotional state that I was definitely no stranger to: that desperate, depressed, and anxious feeling. That worry that your whole life is going to fall apart and that everyone is going to leave you all alone. That worry that something absolutely terrible was going to happen.

I experienced these types of episodes (literally) about every 6 months for as long as I can remember. Usually, I would end up in the emergency room.  Years ago, I would go in and tell the nurse that I was having thoughts about harming myself. Almost always, they hospitalized me (in-patient) for anywhere from 3-14 days.  As time went on, I admitted myself to psychiatry less and less. I desperately wanted to have a "normal" life like, seemingly, everyone around me. I wanted to hold down a job, have friends, and be self-sufficient.  Although my intentions were good and admirable, I unfortunately lacked the skills to take the actions needed to reach these goals. Also, I was working hard to stay out of the hospital for my new boyfriend at the time, who told me that I "didn't "need to be in those places" and that he would leave me if I went in again. The terror of losing him/him abandoning me was far more scary than not receiving the attention, comfort, and safety that I felt when I was cared for by the staff in the psychiatry department.

While I stopped admitting myself to the hospital for overtly psychiatric reasons and complaints, I continued to have an episode about every 6 months, and I'd find myself in the emergency room. Wait. That sounds passive. I chose to go to the emergency room.

I'd become dehydrated from getting myself so worked up, combined with a lack of appetite, vomiting, and, you know what else comes along with all of that when you are really stressed and nervous. I couldn't see it then, but I can see it now: I manifested PTSD in physical symptoms. This way, I could still go to the hospital and feel loved and taken care of, but my boyfriend wouldn't leave -- surely physical sickness couldn't be my fault.  My nervous system would go into overdrive because of some trigger. Sometimes I would know what had caused my distress, and other times I wouldn't (these episodes would be even more terrifying, because I would worry that something actually were physically wrong with me and that I might die), but up until I started DBT (Dialectical Behavior Therapy), I really didn't know what triggers were or how to cope when they arose. So, instead, I fell apart. I would beg others in desperation to save me from myself - to help me. I felt very dependent.

Image Courtesy of University of Florida
I also had no idea, no consciousness, no mindfulness that this was, in fact what I was doing.  I didn't really begin to "get it" and to subsequently learn how to handle such episodes until I really embraced and dived into DBT.  At first, I was so desperate for anything that would make me feel better, that I threw myself into the classwork and homework.  I participated actively in the group therapy, even though I remained pretty skeptical that any of this was really going to help me.  I figured I was worse than most of the people they had been used to dealing with.

And, at first, I really didn't notice anything. I thought it was a bunch of psycho babble that really wasn't impacting my life. Still desperate for some glimmer of hope that this could be the program that helped me figure out who I was, how to take care of myself, and how to stop hurting myself and sabotaging my life, I didn't give up. This was unusual for me. I've given up on almost everything that had been difficult for too long. I wanted this badly.

I can now tell you that, while I still have very difficult days (even just this past week!), I am doing a lot better. I continue to attend weekly DBT meetings. I do the homework. I participate in the group therapy.  I practice the DBT Skills on pretty much a daily basis.

I've noticed that, while I still have immense room for improvement in many areas (especially relationships/making and keeping friendships), I have improved when it comes to emotion regulation.  No longer do my feelings dictate my life. There have been times when I wanted to quit my job due to intense, difficult emotions, but I didn't. Now there is space between the impulse and the reaction. This is something we learn in the mindfulness module of the course.

There have been so many instances where I could have made an impulsive decision that may have relieved my anxiety or despair in that moment but would ultimately sabotage my life in the long term, but I didn't. I used my DBT skills instead.

I'm very grateful that Dr. Marsha Linehan founded this program. It is really changing my life for the better...and if you want it bad enough, and you're willing to do the work, it can change yours, too.

Thank you for reading.
More Soon. 

Addicted to Ativan (Lorazapam)

I met with my psychiatrist yesterday for our quarterly appointment to discuss my meds and how I'm doing.

Among other things, I brought up that I would like to, at some point, get off of the drug Ativan (Lorazapam).  I was first prescribed the drug over a decade ago, and I've used it on and off, as prescribed, for anxiety and insomnia episodes.

At one point, my Dr. had me on 1mg at bedtime, every night.  It was eventually reduced to 0.5mg,  but I haven't been able to kick that teeny tiny amount. I asked her if it was common for people to become addicted/dependent on such a small amount for sleep. Unfortunately, she confirmed that it is.

I noticed on a few occasions when I forgot to take my dose, I tossed and turned all night and barely got any quality sleep. Lo and behold, the next morning, when I went to take my morning meds, I saw that I had forgotten to take the Ativan the night before.

According to my doctor, the process, which she recommends waiting on doing until situations in my life are more stable, involves starting to take a drug called Klonopin, and then tapering off of both drugs.

She then said, "Or you might just need to stay on it."

I was a bit upset. "I'd actually really like to work on this."

She said that sleep is more important right now and that she recommended that we talk about it more in-depth at my next visit. I really don't want to be addicted to a narcotic for the rest of my life.

Right now, fine, it continues to help me sleep...but this is not supposed to be a long-term drug...and I've been on it for a very long time.

More Soon.

Pap Smear Fear | How to Cope if You Have Had Trauma (or not)

Whether you have trauma in your history or not, a pap smear can be a frightening medical exam. For the past few months I've dreaded, on some level, having my exam, which occurs every 3 years.  The last time I had it done, I had a full-blown anxiety attack and went into what I can only describe as a PTSD episode, with no specific recollection of the actual trigger.

Maybe there isn't one. Maybe just the act of being in the nude, with legs up in stirrups is enough vulnerablity for anyone - let alone someone who has mental health issues.

I did some things to prepare myself for this morning's visit.  This appointment was my second attempt to have the exam done. I had cancelled the first.  I don't even remember the "reason." But I know the true reason: I wasn't ready. I was too scared. So, I reminded myself that the more I put this off, the more anxiety I would have to live with up until each appointment.

Secondly, for the past week, I've been getting into position on the couch, with my legs up and on the arm, sort of in the position I would find myself in the OB/GYN table. The first time I did it, I felt very anxious. I literally had an anxiety attack and said to myself "I can't do it. I can't go through with it." But the wise mind knew differently. I acknowledged that if I would continue to practice this "exposure therapy," it would get easier each time. So, almost every night, I got into position. Each time, it got a little less scary.

I used my imagination to more vividly envision the doctor's office...what she might say...how I might feel.

This morning, although I showered last night, I showered again. I knew I'd feel more confident if I were fresh and clean. 

I got to the office and went through the typical vital signs screening. No surprise - my blood pressure (still normal) was a bit elevated.

When my Dr. came into the room, she asked me typical questions. I remained as calm as possible and engaged in friendly small talk with her.  It helped.  I am sure I was visibly nervous...if not at first, then definitely when she began the physical exam and repeatedly told me in a soft, gentle voice, "Relax your muscles for me honey."  It was difficult. I apologized to her. I told her I was embarassed.

She said there as no need for an apology and to please not feel embarassed. She said there was no need for that either. I told her that I was feeling vulnerable, and she reminded me of how normal that was. I said that I was probably her worst patient. She reassured me that there is "always someone better and worse than you."  I smiled. The whole time, the exam was going on.

I had a very difficult time relaxing my muscles - so much so that she had me hold my knees to my chest as if I were "pushing out a visual." :-D

I focused on the cute "wall of babies next to me."

All in all, the exam, from the pap smear to the internal paplitating to the breast exam, came to about 5 minutes. When it was over, I felt so proud of myself. What might be a routine and ordinary exam for a lot of women was a real challenge for me.

A pap smear saved my mother's life. They found cancer cells in her and had to do a hysterectomy.  I reminded myself of how lucky I am to have health insurance and have access to these types of preventative care.

Yaay for another 3 years before I have to face it again!

What DBT (Dialectical Behavior Therapy) skills did I use? Which ones could I have used? Do you ever have similar experiences with medical or dental procedures? How do you cope?

Thanks for reading. More soon.

BPD & Difficulty with Relationships | I'm Sorry Jenny

On my way to the grocery store just now, as I approached the stop sign,  I saw an old friend and colleague get into her car. It was so good to see her face. I gently waved.

Things ended on bad terms between us, but the bitterness that remains with her surprised and hurt me. She stared at me with the chilliest, anger-filled expression, grabbed the door to her truck, got in, and slammed the door.

It all happened so quickly, but it seemed like a small eternity.

Jenny (not her real name), was my colleague and friend a couple of years ago. Her Dad owns a small business, and I worked there for a few months before I became ill.  An out-of-nowhere PTSD episode kicked in after a required business trip to Atlanta, and when I returned, I could barely function.

Due to my weekly DBT (Dialectical Behavior Therapy) classes, I now have the tools to handle such situations and am in a much better place, but at that time, I really lost it. I couldn't eat. I was having anxiety attacks. It was really something. 

My doctor recommended that I attend an intensive program until I was able to pick up the pieces and become stable in mind and body.  I also knew that my spirit needed this as well. It was during this intensive outpatient experience that I was diagnosed with Borderline Personality Disorder (BPD), and much of my life began to make sense. I felt that finally, there was a name for what I was going through - and more importantly, treatment.

During my doctor recommended time off, I sometimes posted pics to Facebooks of things I was doing to try to cheer up and stay positive (for example, I dressed up for Halloween and went out to eat with friends.) Because Jenny and I were also Facebook friends, it turned out to not be such a good idea to do this. I believe that she saw these pics as indications that I was laughing it up, having a great time, and goofing off.  

What's more is that I was unable to return to my position, leaving her father and her in a stressful situation.

I can completely understand why Jenny would feel upset.  I tried to resolve things with her and explain, but she is a bit stubborn and holds grudges. It just didn't work.

It's too bad. In the short time we spent together, in typical BPD fashion, I got very attached. I adored her and looked forward to when she came into work.  All I can do now is know that, in my heart, I have sent her love and apologies. I also know that I will handle similar situations differently in the future. That's all we can do: learn and grow.

Much love to you, Jenny. 

Thanks for reading. More soon.

I chose this pic to give you an idea of what Jenny looks like. She looks like a young, edgy Debra Messing.


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